Understand How ICD-10 Expands Sepsis Coding

By Cynthia Stewart, CPC, CPC-H, CPMA, CPC-I, CCS-P

Beginning Oct. 1, 2013, diagnosis coding of sepsis, severe sepsis, and septic shock will involve a few changes. For one, you will have many more ICD-10-CM codes from which to choose to fully describe sepsis verses severe sepsis compared to what ICD-9-CM offers. But not everything will change. The code sequencing rules for fully describing the condition of severe sepsis, for example, will remain unchanged with ICD-10-CM. Understanding what will change and what will remain the same will ease the impending transition between code sets.

Get Familiar with Combination Code Usage

Because ICD-10-CM utilizes combination coding, sepsis without acute organ failure will require only one code: the code for the underlying systemic infection (A40.0 – A41.9). Complete and accurate coding of the condition of severe sepsis will continue to require a minimum of two codes. The first code sequenced in this combination identifies the underlying organism (Sepsis, A40.0 – A41.9) or cause of the sepsis (postprocedural infection, trauma, or burn), followed by a code indicating the extent to which the septic condition has progressed: severe sepsis with or without septic shock.

ICD-10-CM splits the condition of severe sepsis with combination codes R65.21 Severe sepsis with septic shock and R65.20 Severe sepsis without septic shock. As with other combination codes, assigning a separate code for septic shock in addition to the combination code is unnecessary. When documented, any associated organ dysfunction should be assigned following the code for severe sepsis. Although the condition of sepsis and its associated code may not be the first listed for the principle diagnosis, the sequencing of these codes remains the same.

Urosepsis Is No Longer Coded

Another change is the deletion of the urosepsis condition and code. Considered in ICD-10-CM as a nonspecific term and not associated with sepsis, the default code for this condition in ICD-9-CM (599.0 Urinary tract infection, site not specified) is not carried forward in ICD-10-CM. If the provider documents this condition, further clarification should be sought prior to coding.  

See How Sepsis Translates

To see how sepsis translates, compare the associated ICD-9-CM and ICD-10-CM codes in Table A.

Table A: Sepsis, Severe Sepsis, and Septic Shock Due to Infectious or Non-infectious Process

Newborn Sepsis Codes Get Specific

ICD-10-CM also will bring changes to newborn sepsis coding, as shown in Table B. ICD-9-CM requires a secondary code in addition to the newborn sepsis code (771.81 Septicemia [sepsis] of newborn) to identify the bacterial infection as the underlying organism. As with non-newborn sepsis codes, ICD-10-CM provides combination codes to identify both the condition of sepsis and the underlying organism (P36 Sepsis of newborn due to streptococcus, group B). If a combination code is not available, assign an additional code to identify the underlying organism (B96). When documented, also assign a code for severe sepsis followed by any associated acute organ dysfunction.

Table B: Newborn Sepsis Coding Comparison

Here’s How Puerperal Sepsis Translates

As shown in Table C, the coding of puerperal sepsis will involve only a change in codes because combination codes for puerperal sepsis and the underlying bacterial cause were not created for ICD-10-CM. Coding for this condition using ICD-10-CM codes will continue to require both the code for puerperal sepsis (O85 Puerperal sepsis) and the code for the underlying infection (B95-B96 Bacterial infections in conditions classified elsewhere). As with ICD-9-CM, do not assign a code for sepsis (A40 – A41) because the code for puerperal sepsis (O85) identifies this condition. If documented, an additional code for severe sepsis (R65.2x) should be assigned, followed by documented associated organ dysfunction.

Table C: Puerperal Sepsis Coding Comparison

Let’s put it all together and compare use of the two code sets by coding these diagnostic statements:

Sepsis due to methicillin susceptible Staphylococcus aureus (MSSA)

ICD-9-CM: 038.11, 995.91

ICD-10-CM: A41.0

Septic shock and respiratory failure due to methicillin resistant Staphylococcus aureus

ICD-9-CM: 038.12, 995.92, 785.52 Septic shock, 518.81 Acute respiratory failure

ICD-10-CM: A41.0, Z16, R65.21, J96.0 Acute respiratory failure

As you can see, the changes in ICD-10-CM coding eliminate ICD-9-CM’s current code redundancy of coding sepsis due to infectious conditions.

The ICD-10-CM coding system more accurately reflects the clinical significance and increased complexity of treating severe sepsis when presenting with septic shock by identifying the presence of this condition. As before, however, the sepsis rules are lengthy and documentation will continue to play a key role in the proper assignment of the new code set. For a successful ICD-10-CM transition, education your providers early on about these and other documentation and coding changes.

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